Provider Demographics
NPI:1861232415
Name:HALLER-KIRBY, JERRYCA BAILEY (MS)
Entity type:Individual
Prefix:MRS
First Name:JERRYCA
Middle Name:BAILEY
Last Name:HALLER-KIRBY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1022 S STANLEY ST
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74074-5461
Mailing Address - Country:US
Mailing Address - Phone:760-234-9707
Mailing Address - Fax:
Practice Address - Street 1:2224 W 12TH AVE
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-5154
Practice Address - Country:US
Practice Address - Phone:405-377-3380
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-30
Last Update Date:2024-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor